Gavilan Manor

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Abdoulaye Zerbo and Aziz Faizi conducted an unannounced one (1) year required visit. LPAs were granted entry by the Assistant Administrator Earlienne Rillo, who was informed of the purpose of visit. At the time of the visit there were no residents residing at the facility. The Assistant Administrator was observed to have obtained proper fingerprint clearance and was associated to the facility. LPAs conducted a tour of the facility with Assistant Administrator Earlienne Rillo. The physical plant is a single-story structure that consist of 3 residents bedrooms, 2 staff bedrooms and 3 bathrooms, a laundry room, a living room, a dining area, a kitchen and attached garage. Water temperature was measured at 112-degree Fahrenheit meeting the requirements. Dishes and utensils were in sufficient supply and in good repair. Knives and other sharp objects are stored in a locked cabinet in the kitchen area . Disinfectant and other cleaning solutions were observed in a locked cabinet in the kitchen. According to Assistant Administrator, there are no firearms on the premises. Resident bedrooms had the required bedding, furniture, and lighting. Smoke and carbon monoxide detectors were observed to be operable. The facility does not have any residents and staff, therefore, there were no staff/resident files for LPAs to review. During today's visit, LPAs did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to Assistant Administrator Earlienne Rillothe state’s words, verbatim · CDSS document, Jan 30, 2026

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Ferrer Sabarias and Abdoulaye Zerbo made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPAs met with applicant, Efren Rillo, who accompanied LPAs for the inspection. The Applicant has submitted an application for six (6) residents. On 6/26/2024 the Riverside County Fire Department approved a fire clearance for six (6) non ambulatory residents. Facility is a one story building with 3 residents bedrooms, 2 staff bedrooms and 3 bathrooms, laundry room, living room, dining area, kitchen and attached garage. LPAs observed clients’ bedrooms with the required bedding and furniture, such as, clean mattresses/linen, night stands, dressers, chairs, lighting, and emergency lighting. Client bathrooms had clean appliances that were operating in safe and sanitary condition and the showers contained non-slip surface. Facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Facility met the required 2-day supply of perishable food and 7-day supply of non-perishable foods. Water temperature in the kitchen and bathrooms measured within regulation at 106.3 degrees F. Client and staff files will be locked in the hallway cabinet. Client medication will be centrally stored and locked in the hallway cabinet. The facility has a pool with the locked fencing requirements. There is a covered patio area with seating for all the clients. All passageways were free from obstruction. LPAs observed two fire extinguishers in the facility with the last service date of 05/24/24. The smoke detectors and carbon monoxide alarms were operational. Applicant stated that there are no known firearms and ammunition on the facility. Continue to LIC809C Continued from LIC809 LPAs observed the required postings of the emergency disaster plan, resident personal rights, complaint procedures, employee rights, visitation rights, facility sketch, and the Long-Term Care Ombudsman poster. Facility contains emergency supplies and first aid kits with the required items. The facility has working telephone in the facility. LPAs observed that the physical plant is clean, in good repair, and to be hazard-free during today’s visit. The applicant has completed COMP III orientation on 11/19/2024 and the Administrator has an active administration certificate valid until 12/16/2024 and CPR/AED/First Aid until 6/24/2026 LPAs determined the facility meets the operational requirements for licensure. The Pre-licensing inspection is complete and has satisfied all requirements in accordance with Title 22, California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to applicant Efren Rillo.the state’s words, verbatim · CDSS document, Nov 21, 2024

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Method: Telephone call with CAB COMP II Participants: Rillo, Efren On 10/22/24, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 22, 2024